More than a quarter of teens at seven Texas high schools reported having sent a 'sext' -- a naked picture of themselves by text or email, researchers found.

Action Points

The term sexting refers to sending, receiving, or forwarding sexually explicit messages or pictures, typically over a cell phone or the Internet. This study found that found that 28% of teens had sent a sext, and 31% had asked someone else for a sext.

Point out that adolescents who engaged in sexting behaviors were more likely to report that they had begun dating and engaged in sexual activity compared with those who did not sext. For girls, sexting was also associated with risky sexual behaviors.

More than a quarter of teens at seven Texas high schools reported having sent a "sext" -- a naked picture of themselves by text or email, researchers found.

Overall, 28% said they had sent a sext and 31% reported asking for one from someone else, according to Jeff Temple, PhD, of the University of Texas Medical Branch in Galveston, and colleagues.

Such sexting behavior was associated with an increased likelihood of dating or having sex for both boys and girls, and with risky sexual behaviors for girls, the researchers reported online in Archives of Pediatrics & Adolescent Medicine.

Because of the high prevalence of sexting, "teen-focused healthcare providers should consider screening for sexting behaviors to provide age-specific education about the potential consequences of sexting and as a mechanism for discussing sexual behaviors," Temple and colleagues wrote.

"Indeed," they continued, "these findings reinforce calls by the American Academy of Pediatrics to discuss teen sexting with patients and patients' parents."

In an accompanying editorial, Megan Moreno, MD, MPH, of the University of Wisconsin-Madison, and Jennifer Whitehill, PhD, of the University of Washington in Seattle, took that advice a step further.

"Healthcare providers and researchers may also consider building education or prevention efforts within social media, as previous work illustrates that teens may be willing to investigate topics such as sexual behavior in a social media setting," they wrote.

Although the issue of sexting receives a lot of attention in the media, little is known about the public health importance of the practice, according to Temple and colleagues. Estimated rates of sexting -- based mainly on online polls or media-generated studies -- have varied widely from 1% to 31%.

Temple and colleagues said that study was limited by using a random-digit dialing approach, which likely underestimated actual sexting behaviors by focusing on households with landlines. Households with landlines -- compared with those that depend on cell phone service -- tend to have less ethnic diversity, higher socioeconomic status, and to be more conservative, the researchers explained.

The participants in the current study are a more representative sample, they argued.

The data came from the Dating it Safe study, a longitudinal study of 10th and 11th grade students from seven public high schools in the Houston area. The participants self-reported their history of dating, sexual behaviors, and sexting.

The current analysis included 948 students -- 56% were girls -- who participated in the second assessment during the study. The students were diverse -- 31.7% Hispanic, 30.3% non-Hispanic white, 26.6% non-Hispanic black, 3.4% Asian, and 8% other.

Their ages ranged from 14 to 19 (mean age 15.8).

The rate of having sent a sext was similar in boys (27.8%) and girls (27.5%), but the other variables showed distinct sex differences.

Boys were significantly more likely than girls to have asked someone for a sext (46% versus 21%) and significantly less likely than girls to have been asked for a sext (42.1% versus 68.4%).

Most students of both sexes said they were at least a little bothered when asked for a sext, but girls were much more likely than boys to report being bothered "a great deal" by such a request (27% versus 3%, P<0.01).

The finding that teens who participated in sending or asking for sexts -- both boys and girls -- were more likely to have begun dating or having sex suggests that sexting occurs within the confines of dating, although the researchers did not have information on who was sending or receiving the sexts on the other end.

Among boys, the only factor associated with risky sexual behaviors -- having more than one sexual partner in the last year and using alcohol or drugs before sex -- was having been asked to send a sext.

Among girls, however, a wider range of sexting behaviors -- sending, asking for, or getting asked for a sext -- all were associated with those risky behaviors.

In addition to supporting the possible need to screening for sexting behaviors, Temple and colleagues noted that the high prevalence of such behavior supports efforts to soften criminal penalties for sexting, which could under most existing laws result in child pornography charges.

The authors acknowledged a number of limitations of the study, ranging from the inability to determine "whether adolescents' sexual experiences and engagement in risky sexual behaviors preceded or followed sexting behaviors," to the possibility that the questions asked were not appropriate for a teen audience.

And they they cautioned that although the same represents a diverse cross section of students from several high schools/districts, it is possible that regional differences influenced prevalence estimates."

Temple's work is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The study was also made possible with funding from the Hogg Foundation for Mental Health and the John Sealy Memorial Endowment Fund for Biomedical Research. One of Temple's co-authors reported support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The editorialists reported that they had no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.